And he could cancel advertising and other efforts to encourage enrollment under the Affordable Care Act when the annual sign-up period begins in November. A barrage of negative statements from the administration could project an official view that the health law is collapsing, creating a self-fulfilling prophecy.<\/p>\n The lack of certainty over the subsidy payments, which go toward reducing out-of-pocket costs for low-income people, has been a major concern for insurers. The companies say premiums will be significantly higher without the funding, and some companies that have submitted rates to sell insurance in the market next year could decide to pull out.<\/p>\n \u201cWith open enrollment for 2018 only three months away, our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them,\u201d said Justine Handelman, a senior executive at the Blue Cross Blue Shield Association.<\/p>\n While Mr. Trump has promised destruction, other Republicans signaled that they wanted to take a more constructive approach. Senator Lamar Alexander of Tennessee, chairman of the Senate health committee, announced that he would hold hearings in the next few weeks on stabilizing the individual health insurance market.<\/p>\n Members of both parties have ideas about how to stabilize insurance markets and hold down premiums. One possible action is to provide money for the payments to insurers for reducing customers\u2019 out-of-pocket costs. In addition, two Democratic senators, Thomas R. Carper of Delaware and Tim Kaine of Virginia, want the federal government to help pay the largest claims through a backstop known as reinsurance. Senators of both parties also want to help people in counties where no insurer chooses to offer health plans through the Affordable Care Act marketplace \u2014 a real possibility in some places next year.<\/p>\n The Senate Democratic leader, Chuck Schumer of New York, implored Republicans to defy Mr. Trump and work with Democrats to strengthen insurance markets.<\/p>\n Advertisement<\/p>\n Continue reading the main story<\/a><\/p>\n \u201cThere\u2019s a fork in the road for our Republican colleagues,\u201d he said in an interview. \u201cThey can do what Donald Trump<\/a> said, which is sabotage the system out of anger and out of pique,\u201d or they can work with Democrats on improvements to the health law.<\/p>\n \u201cWhether they can resist Trump, I don\u2019t know,\u201d Mr. Schumer said.<\/p>\n On Capitol Hill, Republicans and Democrats alike were trying to make sense of the repeal effort\u2019s apparent downfall \u2014 and figure out what comes next.<\/p>\n The beginning of the end was on Monday night, when two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition<\/a> to the latest version of Mr. McConnell\u2019s bill to repeal and replace the health law. That left Republican leaders at least two votes short of what they needed to start debate.<\/p>\n Two other Republican senators, Ms. Collins and Rand Paul of Kentucky, had objected last week.<\/p>\n Mr. McConnell responded by outlining plans for a vote on a measure like the one vetoed by Mr. Obama in January 2016<\/a>, which Mr. McConnell said would consist of a \u201crepeal of Obamacare combined with a stable, two-year transition period.\u201d<\/p>\n Since his campaign, President Trump and the Republican Party have pushed hard for a repeal of the Affordable Care Act.<\/p>\n Republican leaders had originally intended to proceed with a similar \u201crepeal and delay\u201d strategy<\/a> after Mr. Trump won the presidency. But in January, Mr. Trump made clear<\/a> he wanted a simultaneous repeal and replacement of the law, and congressional Republicans decided to follow that path.<\/p>\n A repeal-only route would have been disruptive. The Congressional Budget Office said<\/a> in January that enacting the vetoed bill would increase the number of uninsured Americans by 18 million in the first year and 32 million by 2026, compared with current law. Premiums, it said, would increase 20 to 25 percent in the first year and double by 2026.<\/p>\n That bill would have eliminated the Affordable Care Act\u2019s expansion of Medicaid<\/a> and subsidies for the purchase of private insurance. But it would have left in place the law\u2019s requirement that insurers provide specific benefits, and the prohibition on denying coverage or charging higher premiums because of a person\u2019s pre-existing medical conditions.<\/p>\n Advertisement<\/p>\n Continue reading the main story<\/a><\/p>\n The repeal-only idea quickly ran into a wall on Tuesday.<\/p>\n \u201cI did not come to Washington to hurt people,\u201d Ms. Capito said in a statement, taking issue with both Mr. McConnell\u2019s bill and the idea of repealing the health law \u201cwithout a replacement plan that addresses my concerns and the needs of West Virginians.\u201d<\/p>\n Ms. Murkowski said, \u201cThere\u2019s enough chaos and uncertainty already, and this would just contribute to it.\u201d<\/p>\n The idea of repealing the health law without providing a replacement also spooked a bipartisan group of 11 governors, including Brian Sandoval of Nevada, an influential Republican critic of Mr. McConnell\u2019s bill.<\/p>\n \u201cThe Senate should immediately reject efforts to \u2018repeal\u2019 the current system and replace sometime later,\u201d said the group, which included five Republicans, five Democrats and one independent. \u201cThis could leave millions of Americans without coverage. The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets.\u201d<\/p>\n Mr. McConnell appears determined to drive the effort to a final public showdown with a procedural vote that would let the Senate consider the repeal-only measure. He can afford to lose only two Republican senators, with Vice President Mike Pence breaking the tie. But he already appears to have lost at least three: Ms. Collins, Ms. Murkowski and Ms. Capito.<\/p>\n![\"\"](\"https:\/\/static01.nyt.com\/images\/2017\/07\/19\/us\/19dc-health2\/19dc-health2-master675.jpg\")
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\n Credit<\/span>
\n Doug Mills\/The New York Times <\/span>
\n <\/figcaption><\/figure>\nTrumpcare: How Republicans Have Tried to Sell It<\/h4>\n
\n By DAVE HORN and ROBIN LINDSAY on Publish Date <\/span>July 18, 2017.
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\n Photo by Stephen Crowley\/The New York Times.
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\n Watch in Times Video \u00bb<\/a><\/p>\n<\/figcaption><\/figure>\n![\"\"](\"https:\/\/static01.nyt.com\/images\/2017\/07\/19\/us\/19dc-health3\/19dc-health3-master675.jpg\")
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\n Credit<\/span>
\n Eric Thayer for The New York Times <\/span>
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